Provider Demographics
NPI:1992821995
Name:FIRESTONE, LAURA (MS)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:FIRESTONE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3130
Mailing Address - Country:US
Mailing Address - Phone:415-343-5047
Mailing Address - Fax:
Practice Address - Street 1:1732 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3130
Practice Address - Country:US
Practice Address - Phone:415-343-5047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist